This is a blog I've started to help me deal with the diagnosis of having gastroparesis. It was suggested to me that a blog/diary might help me feel better by venting my frustrations and struggles. Also, I hope I can help others who may have the same thing through my own experiences.
For more information, please email: emilysstomach[at]gmail.com or follow on Twitter: www.twitter.com/emilysstomach or like us on Facebook: http://www.facebook.com/emilysstomach

Wednesday, December 13, 2017

A lot of people do not realize that Gastroparesis can really effect your dental health. I brush my teeth and use mouthwash, although I do not floss as much as I should. I also vomit a lot with Gastroparesis, and most of what I vomit is stomach acid. Stomach acid, in itself, is rough on your teeth because it strips the enamel from your teeth and it makes your teeth weaker. It also opens your teeth up to cavities and to breakages, because they are not as strong and protected without the enamel.

To say the least, it has been rough on mine and I have been throwing up for years. This year, however, I have broken three teeth - I broke two back molars three days ago. I thought I had only broken one, but as it turns out, I broke another molar. I went to the dentist today and they could not save the very lower left back molar I broke, because once they cleared the cavity out, there was not enough tooth left to even salvage. They could save the other molar, though, by bone grafts and an implant. This is a VERY expensive treatment. I'm very lucky I have dental insurance, and they do cover implants which is quite rare, but I still have to pay out of pocket and it is going to be a bill over a thousand dollars. Most people cannot afford treatments like this. I'm fortunate I can.

But, I wanted to write this article to bring awareness to the fact that Gastroparesis can cause other secondary issues. We do not just suffer from Gastroparesis and what it does to us - the vomiting, cramping, pain, the inability to digest food, etc. It can also cause issues that people would not think of - like dental issues or back problems. I'm going to focus on the dental issues in this article, since I'm dealing with just those issues right now.

"Oral health professionals should be prepared to identify clinical findings associated with diagnosed or undiagnosed gastric diseases, dietary habits and psychological disorders (such as bulimia) that may result in vomiting and reflux. Gastric fluids are composed of hydrochloric acid, which may have a pH of 1.0 to 2.0.1 These strong acids can soften enamel and dentin, increasing the risk of tooth surface loss caused by bruxing, toothbrushing, or consuming hard or abrasive foods.2 In addition to the intrinsic effects of gastric fluids, erosive tooth wear may also be related to the extrinsic dietary acids found in many foods and sugar-sweetened beverages.3 As such, when erosion is detected, oral health professionals should identify its etiology and institute behavioral and preventive strategies to manage it.4 Gastroparesis is one example of a gastric condition that can have significant oral health consequences. In order to help guide clinicians toward effective management strategies, this article presents a case study of erosive tooth wear attributed to this condition.

Gastroparesis is a chronic gastrointestinal motility disorder characterized by delayed gastric emptying;5 patients experience partial paralysis of the stomach, which results in food retention in the stomach for extended periods. Symptoms include nausea, vomiting and bloating.5,6 Patients with gastric disorders who seek medical treatment are provided with dietary counseling and may be prescribed medications to alleviate symptoms. When taking medical histories, oral health professionals should ask if the patient has been diagnosed with gastroparesis or other gastric disorders in order to plan appropriate treatment.7

CASE REPORT

For example, the medical history of a woman with the chief complaint of extremely sensitive teeth revealed a diagnosis of gastroparesis. The patient was taking esomeprazole and omeprazole, both of which are proton pump inhibitors that suppress production of gastric acids. In addition to the pain and functional difficulties her dentition was causing, the patient was self-conscious about her smile (Figure 1). A comprehensive examination revealed erosion with dentin exposure, staining, decalcification, noncarious cervical lesions and gingival recession. These were noted in her record. The patient’s gingival display was adequate and within normal limits. A caries risk assessment was completed and, due to low salivary pH and hyposalivation, her risk level was deemed high.

The patient in this case report presented with erosion and dentin exposure, which made her self-conscious about her smile.
FIGURE 1.The patient in this case report presented with erosion and dentin exposure, which made her self-conscious about her smile.
A treatment plan was formulated and discussed with the patient. A diagnostic wax-up of the proposed occlusal scheme was completed (Figure 2). Oral hygiene instructions were presented. The patient was prescribed a high-fluoride toothpaste and given xylitol mints and oral spray containing a pH-neutralizing agent.8 The patient was also counseled about dietary habits. Additionally, the oral side effects of her gastroparesis medications — including decreased salivary flow leading to xerostomia — were discussed.

FIGURE 2. A diagnostic wax-up of the proposed occlusal scheme was created.**
FIGURE 2. A diagnostic wax-up of
the proposed occlusal scheme was
created.
FIGURE 3. A splint was fabricated at the new vertical dimension of occlusion.
FIGURE 3. A splint was fabricated
at the new vertical dimension of
occlusion.
FIGURE 4. Temporary splinted composite onlays were placed at the new vertical dimension of occlusion.
FIGURE 4. Temporary splinted
composite onlays were placed at the
new vertical dimension of occlusion.

After reevaluating the patient’s caries risk level, an esthetic treatment plan was formulated. Lithium disilicate onlays were planned for teeth #18, #19, #20 and #29. Lithium disilicate crowns were planned for teeth #21, #28, #30 and #31. These all-ceramic crowns have high success rates.9 Composite buildups were planned for teeth #22 through #27. Because the patient’s periodontal condition was stable, with no biologic width problems, crown lengthening and gingivectomy were not required. The decision was made to increase the vertical dimension of occlusion due to the loss of tooth structure during conservative preparation.10

FIGURES 5A and 5B. The posterior teeth and quadrants were prepared to receive lithium disilicate onlays and crowns.
FIGURES 5A and 5B. The posterior teeth and quadrants were prepared to receive lithium disilicate onlays and crowns.
The patient accepted the proposed treatment plan. A smile design was completed based on the wax-up, and the patient was eager to begin treatment. Before preparing the teeth, the patient was placed in temporary splinted composite overlays at the new vertical dimension of occlusion (Figure 3 and Figure 4). The patient adapted well to these changes.

FIGURES 6A through 6C. Posterior lithium disilicate onlays and crowns are ready to be delivered.
FIGURES 6A through 6C. Posterior lithium disilicate onlays and crowns are ready to be delivered.
With the new vertical dimensions of occlusion, the maxillary anterior teeth were prepared for crowns. Anterior teeth #6 to #11 were prepared, impressed and temporized for lithium disilicate restorations. At the next appointment, lithium disilicate crowns were applied to teeth #6 through #11. The patient indicated she was pleased with the esthetic result. At the following appointments, posterior quadrants were prepared and restored sequentially, using bonded lithium disilicate onlays and crowns (Figures 5A and 5B; Figures 6A through 6C). Composite buildups were completed on the lower anterior teeth #22 through #27. The treatment eliminated the patient’s dentinal hypersensitivity and improved oral function and appearance (Figures 7A and 7B).

FIGURES 7A and 7B. The patient reported being pleased with the final results. The therapy eliminated hypersensitivity and improved oral function and appearance.
FIGURES 7A and 7B. The patient reported being pleased with the final results. The therapy eliminated hypersensitivity and improved oral function and appearance.

DISCUSSION AND CONCLUSION

As noted, dental professionals should be able to identify dental erosion and erosive tooth wear,11,12and be adept at recognizing the signs of dental erosion, determining the etiology, and discussing clinical findings with patients. Sensitive findings in the medical history, such as the effects of eating disorders (e.g., anorexia or bulimia), should be handled cautiously.7 Patients who are unaware that gastric acid may cause erosion should be referred to their physician for additional diagnostic testing. Patients should also be educated about the risks acid reflux poses to oral and systemic health. In cases in which it is determined that erosive tooth wear is due to dietary habits, patients should be advised to limit their intake of acidic foods and beverages.13 They need to understand that it is far better to manage tooth surface loss early, as opposed to taking a 'wait-and-watch' approach that may lead to more extensive and expensive restorative dentistry.

These patients should be placed on a frequent recare schedule that includes regular caries risk assessment, monitoring of dietary acid intake, and reinforcement of preventive strategies. This will help to support patients’ oral health, as well as restoration stability and longevity.

Even though the etiology of dental erosion is multifactorial, clinicians should be able to identify possible causes and discuss these with patients. Oral health professionals should also work with patients’ physicians to ensure appropriate counseling and treatment. In addition to managing erosive tooth wear, it is important for dental team members to understand the need to educate patients about the causes of erosion — and what can be done to prevent its potentially damaging oral health consequences.

KEY TAKEAWAYS

Whether the result of gastric disease, dietary habits or psychological disorders (such as bulimia), the introduction of gastric acids into the oral cavity can have negative ramifications for oral health.
Potential consequences include softening of enamel and dentin that increases the risk of tooth surface loss caused by bruxing, aggressive toothbrushing, or consuming hard or abrasive foods.2
When erosion is detected, oral health professionals should seek to identify its etiology, and institute behavioral and preventive strategies to manage it.4
When taking medical histories, dental professionals should ask if the patient has been diagnosed with gastric disorders in order to plan effective treatment.7
As appropriate, patients who are unaware that gastric acid may cause erosion should be referred to a physician for additional diagnostic testing. Patients should also be advised about the risks acid reflux poses to oral and systemic health.
These patients should be placed on a frequent recare schedule that includes regular caries risk assessment, monitoring of dietary acid intake, and reinforcement of preventive strategies.

ACKNOWLEDGEMENT

The authors would like to thank Susan Do, DDS, for providing the images.

From Decisions in Dentistry. February 2017;3(2):28–31.
**SIDENOTE: You can see the figures and diagrams by clicking on the link above."

My friend Robin decided to go with an implant instead of a crown. She said that even stomach acid (GERD or if you vomit it up) can still get under a crown and decay your tooth.

She says about her x-ray (pictured above),

"Tooth on left has a crown-decay under gum. Tooth on right has filling- decay under gum line. That foreign object is a Bicon Implant. Stomach acid ate my teeth from under gum line. Mine is from acid backwash at night"

"You call it a cavity. Your dentist calls it tooth decay or dental caries. They're all names for a hole in your tooth. The cause of tooth decay is plaque, a sticky substance in your mouth made up mostly of germs. Tooth decay starts in the outer layer, called the enamel. Without a filling, the decay can get deep into the tooth and its nerves and cause a toothache or abscess." This is according to Medline Plus (https://medlineplus.gov/toothdecay.html).

"Even though the etiology of dental erosion is multifactorial, oral health professionals should be able to identify possible causes and discuss these with the patient. Educating patients on causes of dental erosion is important in clinical practice. Oral health professionals should work with patients' physicians to ensure proper counseling and treatment management. In particular, dental hygienists can play a key role in the identification and management of severe erosive tooth wear."

So, what that means for us Gastroparesis warriors is that we are just going to have to stay away from acidic foods (if you can tolerate them), and continue to brush/floss daily. We should go in for regular cleanings but be sure to tell the hygienist or dentist you have Gastroparesis, even if you have to explain it to them. If you can get your medical records from your GI to bring with you to the dentist, they may have a better idea of where your treatment is at and what you are doing - what medications you could be on that might help erode enamel/teeth quicker, and that sort of thing. It's important to call the dentist as soon as a tooth starts bothering you. Do not wait, because if you wait, it could break like mine did, or be a lot more expensive to fix in the long run. So basically, all we can really do is stay on top of our dental health, which is hard since we have SO MUCH to keep up with health wise - records, doctor's visits, and so on. But, I haven't been able to find too many articles about tooth decay and Gastroparesis except for the one study above. I hope this helps you some. If I learn more, I will update this article.

Saturday, December 2, 2017

I have noticed in my support groups that a lot more people are being diagnosed with POTS and Dysautonomia. I have been asked if it is related to Gastroparesis, since they were diagnosed with the others after the initial diagnosis of Gastroparesis. I wanted to write an article on POTS and Dysautonomia to not only help those newly diagnosed, but to explain the connection between the two and Gastroparesis. I especially wanted to write about Dysautonomia because October is Dysautonomia Awareness Month.

Dysautonomia refers to a disorder of autonomic nervous system (ANS) function that generally involves failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia involving excessive or overactive ANS actions also can occur. Dysautonomia can be local, as in reflex sympathetic dystrophy, or generalized, as in pure autonomic failure. It can be acute and reversible, as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions such as diabetes and alcoholism can include dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson's disease. Other diseases with generalized, primary dysautonomia include multiple system atrophy and familial dysautonomia. Hallmarks of generalized dysautonomia due to sympathetic failure are impotence (in men) and a fall in blood pressure during standing (orthostatic hypotension). Excessive sympathetic activity can present as hypertension or a rapid pulse rate.

Is there any treatment?

There is usually no cure for dysautonomia. Secondary forms may improve with treatment of the underlying disease. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic hypotension include elevation of the head of the bed, water bolus (rapid infusion of water given intravenously), a high-salt diet, and drugs such as fludrocortisone and midodrine.

What is the prognosis?

The outlook for individuals with dysautonomia depends on the particular diagnostic category. People with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration have a generally poor long-term prognosis. Death can occur from pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.

What research is being done?

The NINDS supports and conducts research on dysautonomia. This research aims to discover ways to diagnose, treat, and, ultimately, prevent these disorders.

Source: National Institutes of Health; National Institute of Neurological Disorders and Stroke NINDS

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/11/2015...#6004"

Wednesday, November 8, 2017

I have written a series of articles over the years but wanted to put them together, sort them, if you will, so that they would be much easier to get to. I wanted to put them all together in a post to help people find the information they may need right at the moment, so they do not have to hunt through 200 posts. All you have to do is click on the bold, capital letters to reach the articles listed below.

HOW TO DEAL WITH THE SITUATION, "BUT YOU DON'T LOOK SICK!" This article goes into detail about how people who say we don't look sick, even though they might mean well, of how it does more harm than good. Some people do not realize this and think that they're being helpful, or even nice. The article goes into detail about why it's a bad thing to say.

RESOURCES TO EXPLAIN DTP/GP OR A CHRONIC ILLNESS TO FAMILY AND FRIENDS. This article goes into detail of trying to explain having Gastroparesis/DTP and/or any chronic illness to family and friends. It tries to explain it in a way that healthy people can understand, because I feel, personally, unless you've been there, it's a bit hard to understand. I wanted to try and find a way to get others to understand because I am tired of being doubted. You shouldn't have to fight your family and friends when you already fight with doctors, nurses, etc. There's just not enough energy for that.

ADVOCACY FOR PATIENTS AND FAMILY/FRIENDS OF A CHRONICALLY ILL PATIENT. This article explains how you and your family should be your advocate when navigating the healthcare system. Sometimes, we are too sick to fight for ourselves, and having someone there with you to help you makes a difference. It gives a lot of pointers on how to be your own advocate as well.

GASTROPARESIS PATIENTS VS DRUG SEEKERS. This article explains the difference between drug seekers/addicts and people suffering from Gastroparesis and other chronic illnesses which cause pain. It helps the reader to understand the difference. People who suffer from chronic pain, whether it's from nerve damage or other reasons, constantly have to defend themselves in Emergency Rooms, to doctors, to office staff, to family members, and to friends. It's exhausting, especially when we didn't ask for a chronic illness or chronic pain.

THE GASTROPARESIS DIET & RECIPE HELP/IDEAS. This article was written to help those who have been diagnosed and need to change their dietary needs to accompany the illness that invades their digestive systems. The link to this article is definitely in the articles above, for the newly diagnosed. I have collected no just friendly Gastroparesis food recipes, but also recipes for juicing and smoothies. Unfortunately, it is trial and error for everyone, because everyone's GP is different. You just have to find what works for you. There are also support groups for people who have GP who swap recipes and help each other. Additionally, I have uploaded documents containing information about the Gastroparesis diet that the Mayo Clinic gave me.

GASTROPARESIS' EFFECTS ON DENTAL HEALTH. This article goes into what causes dental issues for Gastroparesis warriors. It explores what causes tooth decay, because many GPers lose their teeth, break teeth, and have horrible cavities. There are a variety of factors from vomiting up stomac acid tomalnjjfgion.

PROGRESSIONAL TIMELINE OF GASTROPARESIS/EDS/DYSAUTONOMIA. This is a request for timelines for those who have been diagnosed with GP/DTP, EDS, and Dysautonomia. I want to do some research and compare timelines between people to see if I can spot a pattern. Hopefully, I can compile enough research to give it to a doctor/researcher who can take the idea and go from there. I thought it would be an interesting project because I know most of my friends diagnosed with GP suffer from EDS and Dysautonomia too. I am curious to see if there's a connection there but I need a large sample size to see if there is.

THE GASTRIC STIMULATOR PART I - PERSONAL STORIES FROM REAL PEOPLE WHO HAVE HAD THE SURGERY. This article contains personal stories from those who have Gastroparesis and have gotten the gastric stimulator/pacemaker surgery to help them eat. On a side note, there is a group that is composed of people who have had the surgery and are able to answer any questions you might have, and it's important to do your own research and ask questions before a major surgery like this. However, keep in mind that everyone is different when it comes to Gastroparesis. The group is listed below in the Resources article and this article.

INFORMATION ON THE VAGUS NERVE. This article goes into detail about the vagus nerve, what it controls and where it runs through your body. The article also has links to the "Vagus Nerve Stimulator" and "The Brain in Your Gut."

THE GASTRIC BYPASS, THE SLEEVE, AND GP. This article goes into detail about the gastric bypass and sleeve, along with personal stories of those with gastroparesis who had these surgeries. I did a year's worth of research into the gastric bypass, because my GI kept insisting that it would help me. However, I decided it was not for me after speaking to GP friends who had it done, and the they experienced horrifying issues. I did upload all of the paperwork tat I was asked to fill out, so you understand the procedure you are comiting to.

GASTROPARESIS RESOURCES & ONLINE GROUPS. This is a link to all kinds of resources for Gastroparesis, including support groups, blogs, Pinterests, etc. A great article to help you, and it is constantly updated with new groups and information about Gastroparesis.

THE IMPACT OF VITAMIN DEFICIENCIES. This article dives into the different vitamin deficiencies and the symptoms for each. If you notice any of these symptoms, please call your doctor immediately. It is easy for people like us to have low vitamins because we cannot eat like "normal" people.

INFORMATION ABOUT MALNUTRITION. This article explores the symptoms of malnutrition, what causes it, how it effects us, and the treatment for it. This, and vitamin deficiencies, are VERY serious! Please call your doctor if you have the issues outlined in this article.

POOP - WHAT THE DIFFERENT COLORS AND SMELLS MEAN. A lot of people are embarrassed to ask this question when something isn't right. However, this article contains charts and sources to help you figure out what is going on. It is NOT a substitution for medical advice from your doctor. You should always call your doctor if you feel like something is wrong or not like it should be. But, for those of you who have questions, this article will help you and maybe even help you write down questions to take with you to the doctor.

DUMPING SYNDROME. This is an article explaining dumping syndrome; What it is, what causes it, and goes into details about it. I have experienced it first hand, when my stomach wants to empty all at once because the bile doesn't have a lot of places to go. It has cited sources, like all of my articles, so that you can read from the source and write down any questions you may have for the doctor.

HOW GP/DTP - PAIN EMOTIONALLY AND PHYSICALLY. This article describes and gives suggestions on how to cope with pain related to Gastroparesis and Digestive Tract Paralysis (DTP). It was compiled from suggestions given by other warriors who are fighting the same fight.

HOW TO STAY MOTIVATED. It is really easy to lose pleasure in things you once loved, and it's hard to look on the bright side when you're constantly sick. However, this article will give some ideas about keeping motivated, even during the worst of times. You're NOT alone!

FEELING GOOD WHEN YOU'RE FEELING DOWN. This article gives pointers on how to stay positive and feel good when you become depressed. We all get really sad every now and then, especially when we're overwhelmed and tired. This article gives some tips that might help. But, if you feel really down all of the time, you need to talk to your doctor.

HANDLING HOLIDAYS WITH A CHRONIC ILLNESS. The holidays are coming up and this article gives tips on how to get through the holidays with a chronic illness like Gastroparesis, because almost or all of our holidays are centered around food.

INFORMATION ABOUT GASTROPARESIS AND TRAVELING WITH GP. This article will give you information on what Gastroparesis is, what causes it, and traveling information. I obtained in depth handouts from the Mayo Clinic and uploaded them for everyone. The article has information from Mayo on how to travel with Gastroparesis, and a link to an article on traveling with a feeding tube. It also has a link to the Gastroparesis diet.

PREGNANCY AND GASTROPARESIS. I've gotten this question a lot too, so I consulted people who have been pregnant with gp, and wrote an article to help those who may be thinking of getting pregnant but worried about their GP.

THE GRIEVING PROCESS FOR A CHRONIC ILLNESS AND HOW TO OVERCOME IT. People go through a mourning process once they are diagnosed with a chronic illness because the things they could do before, they might not be able to do now. Your old life is dead, and you mourn it as you go on with your new life. This article will help with that.

SUICIDE AND CHRONIC ILLNESS. This is an important article because a lot of people with chronic illnesses go through depression. It's important to know when to ask for help and this article is to help prevent more suicides because of chronic illnesses.

Friday, October 27, 2017

I found this article and I thought it was really interesting. It might be a viable, possible treatment for people with gastroparesis. I am not familiar with it, so I apologize for the long article, but I wanted to share it and add it to my blog so that I can reference it later. It makes me happy that doctors are trying to find different treatments to help with gastroparesis and abdominal pain. It is a good step in the right direction. It will also help with pain from fibromyalgia and possibly for migraines as well. I know that it does not work for everyone.
However, I wanted to share the article anyway, to keep it in once place in my blog. Even though it may not work for everyone, I thought it was worth sharing and worth documenting in my blog for future research. The article is below.

Administering percutaneous electrical nerve field stimulation (PENFS) with Neuro-Stim, a FDA-cleared device manufactured by Innovative Health Solutions, in an adolescent population whose primary complaint was gastrointestinal pain, appeared to lessen subjective pain scores, according to findings published in The Lancet Gastroenterology and Hepatology.

The researchers were able to demonstrate that abdominal pain—the primary efficacy outcome of a difference from baseline to treatment—improved significantly in patients who underwent PENFS applied to the ear, as compared to those who had the sham treatment.1 The PENFS device must be applied by a licensed clinician.

A randomized clinical trial in which 115 pediatric patients, ranging in age from 11-18 years old, who presented with abdominal pain related to a functional gastrointestinal (GI) disorder were treated at a single, out-patient clinic in the midwest.1

'We had heard about similar [favorable] results in other chronic pain conditions, but most results were from anecdotal reports,' said senior author Adrian Miranda, MD, a pediatric gastroenterologist and associate professor at the Medical College of Wisconsin in Milwaukee, 'We had to carry out a randomized controlled trial to properly assess the findings,' for GI pain.

More importantly, our preclinical studies demonstrated a reduction in the firing of neurons in the amygdala and spinal cord using the same technology,2 Dr. Miranda told Practical Pain Management, 'These central areas have been proposed by many to play a critical role in the development and maintenance of chronic pain.'

Functional abdominal pain disorders are a group of conditions, such as irritable bowel syndrome, abdominal migraine, and functional abdominal pain syndrome, in which pain is typically the most prominent complaint and symptoms are not caused by other conditions.

Study Design and Methodology

Patients were enrolled in the trial between June 2015 and November 2016. Researchers administered the non-invasive PENFS procedure via the external ear (n = 60) or a sham with no electrical stimulation (n = 55) for four weeks. The procedure was initiated with the intent to modulate central pain pathways. Patients were randomized equally to each arm with stratification based on sex, and presence or absence of nausea. Patients, caregivers, and researchers were blinded to allocation by group.

An outcomes analysis included 57 patients in the PENFS arm and 47 patients in the sham group after patients were excluded for discontinuation of treatment or for having organic disease.1

The primary efficacy endpoint—change in baseline reported abdominal pain—was assessed with the Pain Frequency Severity Duration Scale (PFSD), a subjective tool used to derive a quantifiable pain score in these young participants.1 The researchers used PFSD scores to assess improvements from the worst abdominal pain score as well as from a composite abdominal pain score.

Reduced GI Pain Was Sustained Following Neurostimulation

After three weeks of treatment, patients in the PENFS arm experienced a greater decrease in worst pain compared with patients in the sham arm (median score PENFS 5.0, IQR 4.0 - 7.0; sham 7.0, 5.0 - 9.0). The least-square means estimate of change in worst pain was 2.15 (95% CI: 1.37 - 2.93, P < .0001).1
Median composite scores of PFSD also decreased significantly in the PENFS arm, from 24.5 (IQR 16.8-33.3) to 8.4 (3.2-16.2), compared to the sham arm, which went from 22.8 (8.4-38.2) to 15.2 (4.4-36.8).1
Both worst pain and composite pain effects were reported for a median of 9.2 weeks during follow-up.1 The median worst pain was 2.0 points lower at follow-up in the PENFS arm but only 0.5 points lower in the sham arm (P < .0001). In addition, median composite pain at follow-up was 12.5 points lower in the PENFS arm compared to 6.0 points lower in the sham arm (P=.018).
'I know that ultra-high frequency can cause specific neurochemical changes that decrease pain,' said Dr. Gary W. Jay, MD, a clinical professor in the Headache Division in the Department of Neurology at the University of North Carolina, Chapel Hill.
'While I can at least get some idea as to why the reported pain decreased from this study, we don’t know what the parameters of electronic stimulation were, and they’ve done no testing other than filling out subjective forms, Dr. Jay told Practical Pain Management.
Need for Further Understanding of Longterm Benefits

Dr. Miranda shared some additional information on how persistent this therapy might be at reducing abdominal pain.

'I have patients whose symptoms have resolved and are six months out of treatment while others have recurrence at five months,' he said, 'and it may be that a second treatment is needed for those who have recurrence, or perhaps a longer initial trial of six weeks would be required to prevent relapse.'

'It’s too early to tell, and certainly longitudinal studies need to be done,' Dr. Miranda said, 'Perhaps in the future, this therapy can be combined with imaging techniques to better predict the phenotype that will respond to treatment.'

Dr. Jay concurred with the need for imaging studies, particularly as PFSD is susceptible to issues surrounding subjective measurements. Objective, physiological measurements could yield meaningful insights into the biological basis of the results achieved in this study, according to Dr. Jay. He also noted that the study did not provide sufficient detail about the methodology used to employ electrical stimulation.

'The researchers are not giving us any parameters of what they are doing, and they are also not looking at whether there are any physiological changes occurring,' said Dr. Jay. 'You would want to do functional MRIs to see exactly what is this stimulation is doing.'

'I think we have just started to uncover the possibilities of neuromodulation, using peripheral electrical stimulation. The implications for this type of non-invasive neuromodulatory therapy holds promise beyond just functional pain disorders, in my opinion,' said Dr. Miranda, 'and if you think about the central mechanisms that are involved in chronic pain, there is really no reason why this technology couldn’t be applied to many pain disorders.'

Dr. Jay agreed that neuromodulatory electrical stimulation has the potential to improve other disorders characterized by pain.

'Given that some of the animal studies show amygdala or limbic system involvement secondary to the stimulation, which would make sense in certain disorders, I would want to see trials that at this aspect. The limbic system is very highly incorporated into another so-called functional pain syndrome, fibromyalgia,' he told Practical Pain Management.

Dr. Miranda explained the need for creating distinct therapeutic regimens for individual patients and emphasized the importance of understanding which components could form the foundation for such a regimen, including pharmacotherapy, physical reconditioning, and neuromodulation.

'We need to figure out who our responders are for each treatment and tailor our approach for each patient. There is not one treatment that will work for all patients,' said Dr. Miranda. 'Yet we don’t always discuss these components of treatment with our patients because of time constraints, lack of resources, or issues with insurance coverage,' Dr. Miranda said.

The American Neurogastroenterology and Motility Society funded this research. The authors have no other disclosures.

Sunday, October 1, 2017

Thrush is terrible. I have had it on my tongue and down my esophagus, and I'm not the only one. People in my support groups have had the same. I wanted to look up why this happens more frequently to Gastroparesis Warriors. I mean, I know why thrush happens. It is caused by an imbalance of good and bad bacteria in your body.

"Esophageal Thrush (Candida Esophagitis)
Written by April Kahn and Rachel Nall
Medically Reviewed by Nancy Choi, MD on August 17, 2017

What is esophageal thrush?

Esophageal thrush is a yeast infection of the esophagus. The condition is also known as esophageal candidiasis.
Fungi in the family Candida cause esophageal thrush. There are about 20 species of Candida that can cause the condition, but it’s usually caused by Candida albicans.

Causes:

How does esophageal thrush develop?

Traces of the fungus Candida are normally present on the surface of your skin and within your body. Normally, your immune system can regulate these good and bad organisms in your body. Sometimes, though, a shift in the balance between the Candida and your healthy bacteria can cause the yeast to overgrow and develop into an infection.

Risk factors:

Who is at risk?

If you’re healthy, it’s unlikely you will develop this condition. People with compromised immune systems, such as those with HIV, AIDS, or cancer, and older adults are at a higher risk. Having AIDS is the most common underlying risk factor. According to the Centers for Disease Control and Prevention (CDC), 20 percent of all people with cancer develop the condition.

People with diabetes are also at an increased risk of developing esophageal thrush, especially if their sugar levels are not well controlled. If you have diabetes, there’s often too much sugar present in your saliva. The sugar allows the yeast to thrive. More importantly, uncontrolled diabetes also hurts your immune system, which allows for candida to thrive.

Babies who are born vaginally can develop oral thrush if their mothers had a yeast infection during delivery. Infants can also develop oral thrush from breastfeeding if their mother’s nipples are infected. Developing esophageal thrush this way is uncommon.
There are other risk factors that make someone more likely to develop this condition.

You’re more at risk if you:
smoke
wear dentures or partials
take certain medications, such as antibiotics
use a steroid inhaler for conditions like asthma
have a dry mouth
eat lots of sugary foods
have a chronic disease

Symptoms:

The symptoms of esophageal thrush include:

white lesions on the lining of your esophagus that may look like cottage cheese and may bleed if they’re scraped
pain or discomfort when swallowing
dry mouth
difficulty swallowing
nausea
vomiting
weight loss
chest pain

It’s also possible for esophageal thrush to spread to the inside of your mouth and become oral thrush.

creamy white patches on the inside of the cheeks and on surface of the tongue
white lesions on the roof of your mouth, tonsils, and gums
cracking in the corner of your mouth
Breastfeeding moms can experience Candida infection of the nipples, which they can pass on to their babies.

If you experience these conditions, you should watch your baby for signs of infection. While babies can’t say if they’re feeling bad, they may become more fussy and irritable. They can also have the distinctive white lesions associated with thrush.

If your doctor suspects you might have esophageal thrush, they will do an endoscopic exam.
Endoscopic exam

During this exam, your doctor looks down your throat using an endoscope. This is a small, flexible tube with a tiny camera and a light at the end. This tube can also be lowered into your stomach or intestines to check the extent of the infection.

The goals of treating esophageal thrush are to kill the fungus and prevent it from spreading.

Esophageal thrush warrants systemic antifungal therapy, and an antifungal medication, such as itraconazole, will likely be prescribed. This prevents the fungus from spreading and works to eliminate it from the body. The medication can come in a variety of forms, such as tablets, lozenges, or a liquid that you can swish in your mouth like mouthwash and then swallow.

If your infection is slightly more severe, you may receive an antifungal medication called fluconazole delivered intravenously in the hospital.

People with late-stage HIV might need a stronger medication, such as amphotericin B. Most importantly, treating the HIV is important for controlling the esophageal thrush.

If your esophageal thrush has compromised your ability to eat, your doctor may discuss nutritional options with you. This can include high-protein shakes if you can tolerate them or alternative feeding options, such as a gastric tube in severe situations.

Preventing esophageal thrush:

You can reduce your risk of developing esophageal thrush in the following ways:

Eat yogurt whenever you take antibiotics.
Treat vaginal yeast infections.
Practice good oral hygiene.
Go to your dentist for regular checkups.
Limit the amount of sugary foods you eat.
Limit the amount of foods you eat that contain yeast.

Even though those with HIV and AIDS are at greater risk for esophageal thrush, doctors rarely prescribe preventive antifungal medicines. The yeast could become resistant to treatments. If you have HIV or AIDS, you can reduce your risk of an esophageal thrush infection by taking prescribed antiretroviral therapy (ART) medications.

Future health complications:

The risk for complications after the development of esophageal thrush is higher in people with comprised immune systems. These complications include thrush that spreads to other areas of the body and an inability to swallow.

If you have a compromised immune system, it’s very important to seek treatment for thrush as soon as you notice symptoms. Thrush can easily spread to other parts of your body, including your:

lungs
liver
heart valves
intestines
By receiving treatment as quickly as possible, you can reduce the likelihood that thrush will spread.

Outlook for esophageal thrush:

Esophageal thrush can be painful. If it’s left untreated, it can become a severe and even life-threatening condition. At the first signs of oral thrush or esophageal thrush, talk to your doctor. Esophageal thrush is highly prone to spreading. The more areas of the body affected, the more severe the infection can be. Medications are available to treat esophageal thrush, including antifungal medicines. Prompt and careful treatment can reduce your pain and discomfort.

Oral Thrush: Causes, Symptoms, and TreatmentsBy Christian Nordqvist
Reviewed by University of Illinois-Chicago, School of Medicine

"Oral thrush, also known as oral candidiasis, is a yeast/fungi infection of the genus Candida that develops on the mucous membranes of the mouth.

It is most commonly caused by the fungus Candida albicans, but may also be caused by Candida glabrata or Candida tropicalis.

In this article, we will cover all aspects of oral thrush, including the causes, symptoms, and treatment.

Contents of this article:

Causes
Symptoms
Treatment
Risk factors
Diagnosis
Fast facts on oral thrush
Here are some key points about oral thrush. More detail and supporting information is in the main article.

Oral thrush is a common condition, but for most, it does not cause major problems

Individuals with a reduced immune system are worst affected by oral thrush

Oral thrush can occur more regularly after chemotherapy or radiotherapy to the head and neck

It is more common in people who are taking steroids, wear dentures, or have diabetes
The most obvious symptom of oral thrush is creamy or white-colored deposits in the mouth

What is oral thrush?

Oral thrush is caused by species of Candida fungus.

Oral thrush causes thick white or cream-colored deposits, most commonly on the tongue or inner cheeks. The lesions can be painful and may bleed slightly when they are scraped. The infected mucosa (membrane) of the mouth may appear inflamed and red.

Oral thrush can sometimes spread to the roof of the mouth and the back of the throat.

For the majority of individuals, oral thrush does not cause any serious problems. However, this is not the case for people with a weakened immune system, whose signs and symptoms may be much more severe.

People with poorly controlled diabetes, those taking steroids (especially long-term), as well as individuals who wear dentures, have a higher risk of developing oral thrush with more severe symptoms.

Long-term antibiotic therapy can increase the risk of developing oral thrush. Some medications, especially those that dry out the mouth, can cause oral thrush to develop. Oral thrush is more common among patients who receive chemotherapy or radiotherapy to the head and neck.

The outcome for oral thrush is generally very good. Most people respond well to treatment. However, oral thrush tends to reappear, especially if the causal factor (smoking, for instance) is not removed.

Tiny quantities of Candida fungus exist in various parts of our body, including the digestive system, skin, and mouth, causing virtually no problems to healthy individuals. In fact, C. albicans is carried in the mouths of up to 75 percent of the world's population.

However, people on certain medications, with reduced immune systems, or certain medical conditions are susceptible to oral thrush when C. albicans grows out control.

Symptoms of oral thrush:

Oral thrush in adults generally appears as thick, white or cream-colored deposits (spots) on the mucous membrane of the mouth (wet parts of the inside of the mouth).

The mucosa (mucous membrane) may appear swollen and slightly red. The spots may be raised. There may be discomfort or a burning sensation.

If the cream or white-colored deposits are scraped, bleeding may occur.

The white spots may join together to form larger ones, also known as plaques; these may then take on a grayish or yellowish color.

Occasionally, the affected area simply becomes red and sore, with no detectable white spots.

Individuals who wear dentures may have areas that are constantly red and swollen under a denture. Poor oral hygiene, or not taking the dentures out before going to sleep may increase the risk.

Oral thrush is sometimes divided into three groups based on appearance, although the condition can sometimes sit between categories:

A Doctor checks a patient's throat
Oral thrush is typically diagnosed after an oral examination.Pseudomembranous - the classic and most common version of oral thrush.Erythematous (atrophic) - the condition appears red raw rather than white.Hyperplastic - also referred to as "plaque-like candidiasis" or "nodular candidiasis" due to the presence of a hard to remove solid white plaque. This is the least common variant; it is most often seen in patients with HIV.

There are a number of other lesions that can also appear with oral thrush. Sometimes, these lesions might be due to other types of bacteria that are also present in the area.

These can include:

Angular cheilitis - inflammation and/or splitting in the corners of the mouthMedian rhomboid glossitis - a large, red, painless mark in the center of the tongueLinear gingival erythema - a band of inflammation running across the gums

Treatment of oral thrush:

Doctors will usually prescribe anti-thrush drugs, such as nystatin or miconazole in the form of drops, gel, or lozenges. Alternatively, the patient may be prescribed a topical oral suspension which is washed around the mouth and then swallowed.

Oral or intravenously administered antifungals may be the choice for patients with weakened immune systems. If treatment is not working, amphotericin B may be used; however, this will only be used as a last resort due to the negative side effects which include fever, nausea, and vomiting.

Risk factors for oral thrush:

Adult oral thrush is more likely to become a problem for the following groups:

People who wear dentures - especially if they are not kept clean, do not fit properly, or are not taken out before going to sleep.

Antibiotics - people who are on antibiotics have a higher risk of developing oral thrush. Antibiotics may destroy the bacteria that prevent the Candida from growing out of control.

Excessive mouthwash use - individuals who overuse antibacterial mouthwashes may also destroy bacteria which keep Candida at bay, thus increasing the risk of developing oral thrush.

Steroid medication - long-term use of steroid medication can increase the risk of oral thrush.

Weakened immune system - people with weakened immune systems are more likely to develop oral thrush.

Diabetes - people with diabetes, especially if it is poorly controlled, are more likely to have oral thrush.

Dry mouth - people with less than normal quantities of saliva (xerostomia) are more prone to oral thrush.

Diet - malnutrition predisposes people to oral thrush; this could be caused by a poor diet or a disease that affects the absorption of nutrients. In particular, diets low in iron, vitamin B12, and folic acid appear to affect infection rates.

Smoking - heavy smokers are more at risk, the reasons behind this are unclear.

Diagnosis of oral thrush:

In the vast majority of cases, the doctor can diagnose oral thrush by looking into the patient's mouth and asking some questions about symptoms.

The doctor may scrape some tissue from the inside of the mouth for analysis.

If the doctor believes the oral thrush is being caused by a medication or some other underlying cause, that cause must be dealt with. Treatments in such cases depend on the underlying cause.

I had a suspicion that my Gastroparesis was causing it, with all of vomiting, but had no idea that other chronic illnesses caused this. So, I think the constant vomiting of stomach acid brought on mine. It probably did through off my pH. I learned a lot of new things today and I hope it well help others.

Friday, September 29, 2017

Two months ago, I began shaking in my hands and would eventually have my legs give out, and spasm. It is terrifying, since I do not know what is causing it. I do not think it was a cause of hypoglycemia, because I would have this shaking before without hypoglycemia. I do not know if it related to gastroparesis or not, since the vagus nerve is damaged or even dehydration, or malnutrition. A friend suggested it was an essential tremor, so I wanted to do some research on it.

"Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces.

It's usually not a dangerous condition, but essential tremor typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although it's sometimes confused with Parkinson's disease.

Essential tremor can occur at any age but is most common in people age 40 and older.

Essential tremor signs and symptoms:

Begin gradually, usually on one side of the body
Worsen with movement
Usually occur in the hands first, affecting one hand or both hands
Can include a "yes-yes" or "no-no" motion of the head
May be aggravated by emotional stress, fatigue, caffeine or temperature extremes
Essential tremor vs. Parkinson's disease

Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways:

Timing of tremors. Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson's disease are most prominent when your hands are at your sides or resting in your lap.

Associated conditions. Essential tremor doesn't cause other health problems, but Parkinson's disease is associated with stooped posture, slow movement and shuffling gait. However, people with essential tremor sometimes develop other neurological signs and symptoms, such as an unsteady gait (ataxia).

Parts of body affected. Essential tremor mainly involves your hands, head and voice. Parkinson's disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.

Causes

About half of essential tremor cases appear to result from a genetic mutation, although a specific gene hasn't been identified. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people without a known genetic mutation.

Genetic mutation. The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition.

If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.

Age. Essential tremor is more common in people age 40 and older.

Complications

Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to:

Hold a cup or glass without spilling
Eat normally
Put on makeup or shave
Talk, if your voice box or tongue is affected
Write legibly

Treatment

Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.

Medications

Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Beta blockers may not be an option if you have asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.

Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don't respond to beta blockers. Other medications that might be prescribed include gabapentin (Gralise, Neurontin) and topiramate (Topamax, Qudexy XR). Side effects include drowsiness and nausea, which usually disappear within a short time.

Tranquilizers. Doctors may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.

However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.

Deep brain stimulation might be an option if your tremors are severely disabling and you don't respond to medications.

In deep brain stimulation, doctors insert a long, thin electrical probe into the portion of your brain that causes your tremors (thalamus). A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.

Side effects of surgery can include equipment malfunction; problems with motor control, speech or balance; headaches; and weakness. Side effects often go away after some time or adjustment of the device."

"Essential Tremor (ET) is a nerve disorder characterized by uncontrollable shaking, or 'tremors,' in different parts and on different sides of the body. Areas affected often include the hands, arms, head, larynx (voice box), tongue, and chin. The lower body is rarely affected.

ET is not a life-threatening disorder, unless it prevents a person from caring for him or herself. Most people are able to live normal lives with this condition -- although they may find everyday activities like eating, dressing, or writing difficult. It is only when the tremors become severe that they actually cause disability.

What Causes Essential Tremor?

The true cause of Essential Tremor is still not understood, but it is thought that the abnormal electrical brain activity that causes tremor is processed through the thalamus. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.

Genetics is responsible for causing ET in half of all people with the condition. A child born to a parent with ET will have up to a 50% chance of inheriting the responsible gene, but may never actually experience symptoms. Although ET is more common in the elderly -- and symptoms become more pronounced with age -- it is not a part of the natural aging process."

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age. The disorder generally affects men and women equally.

Tremor is not life threatening. However, it can be embarrassing and even disabling, making it difficult or even impossible to perform work and daily life tasks.

What causes tremor?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. Most types of tremor have no known cause, although there are some forms that appear to be inherited and run in families.

Tremor can occur on its own or be a symptom associated with a number of neurological disorders, including:

a rhythmic shaking in the hands, arms, head, legs, or torso
shaky voice
difficulty writing or drawing
problems holding and controlling utensils, such as a spoon.
Some tremor may be triggered by or become worse during times of stress or strong emotion, when an individual is physically exhausted, or when a person is in certain postures or makes certain movements."

"Muscle shaking, also called essential tremor or muscle fasciculation, is an uncontrollable twitching of your muscles. Muscle shaking is most noticeable in the hands, but also occurs around the neck, eyes and legs. Muscle shaking and tremors are more common among the elderly and sometimes related to senility diseases, such as Parkinson’s and Alzheimer’s disease. Nutritional deficiency is a common cause of abnormal muscle tone and may lead to chronic shaking or twitching of your muscles. Consult with your doctor if your notice that you are unable to keep your hands steady.

Hypoglycemia

Hypoglycemia is defined as low blood sugar, which refers to the amount of glucose circulating in your bloodstream. Glucose is the primary fuel for your brain and needed by virtually all tissues to produce energy. Skipping meals is the most common cause of hypoglycemia, although it also occurs in diabetics who take too much insulin. A primary symptom of hypoglycemia is widespread muscle tremors and weakness, although other common symptoms include 'brain fog,' confusion, fatigue and lethargy, according to the book 'Functional Biochemistry in Health and Disease.' Eating refined carbohydrates or drinking fruit juice often quickly resolves muscle shaking caused by hypoglycemia.

B-Vitamin Deficiency

B-vitamins are needed by your body for metabolism, energy production, nerve function and conductance, enzyme synthesis and red blood cell production. B-vitamins are quickly depleted by stress, toxins and alcoholism, and deficiencies are common in people with poor diets and malabsorption issues, according to 'Metabolic Regulation: A Human Perspective.' B-vitamins most often linked to muscle shakiness because of their importance to nerve function include B-1 or thiamine, B-6 or pyridoxine and B-12 or cobalamin. Deficiencies in these vitamins invariably affect brain function and lead to other neurological problems such as reduced cognition, depression, numbness and tingling in the limbs and loss of balance. Red meat, chicken, fish, beans, nuts and green leafy vegetables are all good sources of B-vitamins.

Magnesium Deficiency

Minerals are also important for nerve function and normal muscle tone. Magnesium is especially important for the relaxation of muscles. Early symptoms of magnesium deficiency can include fatigue, irritability, insomnia and muscle tremors, twitching or shaking, according to 'Functional Biochemistry in Health and Disease.' Prolonged deficiency affects the electrical waves in your brain, heart and skeletal muscles and may be related to chronic muscle cramping and restless leg syndrome. If magnesium deficiency is the cause of your muscle shaking, then magnesium supplementation can lead to dramatic improvement within hours to days.

Dehydration and Electrolyte Imbalance

Dehydration occurs from not drinking enough water or quickly losing too much water from excessive urination, diarrhea or blood loss. Water loss is accompanied by loss of electrolytes such as potassium and sodium, which are salts of the body needed for normal muscle control and nerve function. An early sign of dehydration is muscle shaking or tremors, but muscle cramping, irregular heart beat, fatigue and reduced brain function can quickly follow if your body is not replenished with water and electrolytes. Drinking water devoid of minerals and electrolytes is not enough to return a severely dehydrated person back to health."